Hypertension in 2017 — What Is the Right Target?
JAMA. Published online January 30, 2017.
Suggested BP Goals for Tx of HTN
First, for most adults younger than 50 years, despite the lack of definitive clinical trial data, the goal BP of less than 120/80 mm Hg is recommended based on the wealth of epidemiological data demonstrating an almost linear increase in CVD risk with increasing BP levels above this goal. In the presence of CVD, chronic renal disease, or diabetes, an SBP goal of less than 130 mm Hg seems appropriate. Since the majority of young persons with hypertension have stage 1 hypertension, lifestyle measures should be used initially in most before initiating medications.
Second, for individuals between 50 and 74 years old, a long-term SBP goal of less than 130 mm Hg is appropriate for most patients. However, because of some uncertainties, it would be prudent to first achieve a target of less than 140 mm Hg, and then if treatment to that target is well tolerated, proceed to the lower goal. This approach is recommended irrespective of the presence or absence of CVD or chronic kidney disease. In individuals with type 2 diabetes, the long-term target currently should be an SBP level of less than 140 mm Hg, although a somewhat lower target might be considered in view of the observed benefit of reducing stroke incidence with intensive therapy in ACCORD.
Third, for persons aged 75 years or older, more than 75% of whom have hypertension, reduction of SBP is clearly beneficial, but the exact SBP goal is still unclear. At present, a goal of less than 140 mm Hg appears reasonable but should be achieved by careful titration of medications and monitoring for orthostatic hypotension and changes in renal function and cognition. For individuals who tolerate treatment well, further efforts might be made to reach a target of less than 130 mm Hg, but this may occur in a minority of patients.
The ultimate goal should be to prevent hypertension. Efforts should be intensified rather than simply acknowledged. For persons with prehypertension, particularly with BP levels in the 130-139/85-89 mm Hg range, adoption of healthy lifestyles should be stressed by clinicians to their patients. In addition, use of statins and efforts to stop smoking should be considered in all persons with hypertension to reduce cardiovascular complications.